210 Connect panelists take on mental health issues

Panelists discussed mental health at a recent 210 Connect forum. Martin Velasco-Ramos/Valley Voice

“Schizophrenia. What the hell does that really mean? Am I really all that different? Am I not a human being?”

Olivia Garza shared these words with a full room at Cafe 210. Garza, 35, born and raised in Tulare County, has been struggling with mental illness since she was seven years old. After a long road of drug and alcohol abuse and a stint with suicide, Garza has been in recovery for over 15 years. And on March 9, she joined a panel of mental health professionals for the 210 Connect Forum on Mental Health.

Joining Garza on the panel were Cassie Ennis, LMFT, from Tulare County Health and Human Services Agency(TCHHSA), Jaimie Hinesly from Kaweah Delta Hospital (KDH), Psychiatrist Dr. Mandeep Bagga and President of Tulare County’s National Alliance on Mental Illness (NAMI), Ralph Nelson.

The panel took turns answering questions and concerns from the public. Topics ranged from recognizing signs of crisis to self-care. But the panel also touched on issues that not only affect the individual, but the county and state as a whole.

“I just talked to a lady tonight,” Nelson began. “She wanted to go to a certain psychiatrist and they said there was a six month waiting list…If you have someone who is having a heart attack, you aren’t waiting six months. If you have someone in diabetic acidosis, you aren’t waiting six months. So why in the hell are people with mental illness-in-crisis waiting six months?”

According to Nelson and other members of the panel, there simply aren’t enough psychiatrists and mental health professionals to go around. Most psychiatry graduates usually leave the area for higher paying jobs in prisons or large cities along the coast.

And if you do manage to get a hold of a psychiatrist in Tulare County, you’ll be hard pressed to get a session longer than 15 minutes. It’s a frustrating compromise in an industry that’s notorious for high prices and rarely accepts private insurance.

The mediator asked the panel if this was a problem exclusive to Tulare County or if it was a statewide issue.

Ennis was the first to answer:

“Statewide, but specifically in our county it’s very challenging. Just keeping professionals in the Valley is hard. But when we talk to other counties, they’re still experiencing turnover and losing individuals and not being able to fill their positions. So even though we are struggling it is statewide a problem – probably nationwide.”

Nelson piggybacked off Ennis’ comments and mentioned that in 2006 they were down 40% in mental health providers in California, and he doesn’t believe it has improved much since then.

Ennis also noted that in the last 5-6 years patients seem to be getting “sicker.” Cases have become increasingly complex, requiring more manpower per patient.

“One individual is taking significant amounts of service,” Ennis explained, “where we weren’t seeing that as often in the past.”

These are alarming issues, but the county has taken some measures to alleviate the overwhelming demand for mental health services.

Both TCHHSA and KDH are trying to encourage graduate students to stay in the Valley by offering incentives like internships.

In fact, Dr. Bagga announced his psychiatry program was able to keep two-thirds of its graduates last year, an accomplishment that was met with a resounding applause by the audience.

The county and state are also shifting the way they approach mental health treatment. Previously, clinics and resources required a professional diagnosis before services could be provided. But now, clinics are starting to look at “impairment and functioning first”. This new strategy could speed up the treatment process and reduce the prevalence of chronic complex cases that are clogging up our system.

The panel also took the time to answer some commonly asked questions about treatment, advocacy, and resources surrounding mental illness:

How do you recognize when someone is nearing crisis?

Ennis: “When it gets hard to live, laugh and love. When you or somebody you know is really struggling for a period of time (maybe a couple of weeks) with engaging in relationships, going to school, showing up for work, or getting work done in general – it’s time to talk to somebody.”

Bagga: “Some of the key hallmarks that I tell patients to look out for are trouble sleeping…It’s one of the first signs. Another thing is changes in your appetite…If you see something out of the ordinary, you can ask a question. It would be no different than if somebody you know really well is walking with a limp and you ask them, ‘Hey, why are you limping? Are you okay?’”

Nelson: “The problem is that families do not know anything about mental illness. So they see these little signs that all panel members have talked about, and they say ‘Oh, well that’s a phase’ or ‘That’s a teenage problem’…They’re making excuses. That’s it’s anything else, but not mental illness…So it’s always good to look at those little signs.”

Once a person has been diagnosed, how can loved ones help?

Bagga: “Learn as much as you possibly can. The more educated you can be about the mental illness, the medication, the treatment, and the services, the better equipped you’ll be able to handle situations.”

Ennis: “I think it’s helpful to really sit down and have some advanced directives if something were to happen like a crisis situation, to lay out what that individual would be comfortable with. Knowing what that person’s triggers are, knowing what that person does when they’re struggling, and what the next steps would like.”

Garza: “One thing that has helped me is knowing that my family loves me and that they’re there for me in good times and bad. Sometimes all we need is someone to listen to us and just be a friend.”

How do you navigate through all the health care programs and resources for your loved one?

Ennis: “Advocate, advocate, advocate…In general, it is challenging but there is usually a grievance process and an advocate you can speak to within most departments where you can really share what your challenges are. And they can help you potentially move through those things to get you to the right door.”

Bagga: “Unfortunately for our county, the services that are available for Medi-Cal beneficiaries is actually way better than what is available for private insurance at the moment…So for everybody else that doesn’t have Medi-Cal or doesn’t have insurance…I would emphasize that everybody begin a primary care doctor because your primary care doctor can help guide you and help make referrals to the psychiatrists and to the mental health specialists.”

Nelson: “You just have to advocate. You have to know your insurance company, your insurance agent, you have to know the system. And you have to push…When it comes to mental health, the resources are very limited. You have to use who you know, what you know, and talk about it very insistently….It is true, the squeaky wheel gets the grease.”

What are some things we should remember?

Ennis: “We need to take care of ourselves. We need to make sure that we’re healthy to support that person. And that we can’t fix them, for them. We can’t necessarily force them to stay in treatment.”

Nelson: “Families need to understand they’re actually having serious emotional distress…They need to find some sort of support for themselves…They need to vent. They need to go to find something like a support group (NAMI)…Remember that the person who has had the crisis is not the only person in the family.”

Bagga: “All the therapies are mostly the same, but the thing that matters the most was the connection that you had between the therapist and you…So rather than trying to get in the weeds of what’s the best for me or what should I do, find the therapist that connects with you the best and then you two should come up with a plan together.”

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